Chapter 15. Late (Complicated) Parkinson's Disease

  1. Nils Erik Gilhus MD, PhD Professor22,
  2. Michael P. Barnes MD, FRCP Professor of Neurological Rehabilitation Medical Director23 and
  3. Michael Brainin MD Professor24
  1. W. H. Oertel1,
  2. A. Berardelli2,
  3. B. R. Bloem3,
  4. U. Bonuccelli4,
  5. D. Burn5,
  6. G. Deuschl6,
  7. E. Dietrichs7,
  8. G. Fabbrini2,
  9. J. J. Ferreira8,
  10. A. Friedman9,
  11. P. Kanovsky10,
  12. V. Kostic11,
  13. A. Nieuwboer12,
  14. P. Odin13,14,
  15. W. Poewe15,
  16. O. Rascol16,
  17. C. Sampaio17,
  18. M. Schüpbach17,18,
  19. E. Tolosa19 and
  20. C. Trenkwalder20,21

Published Online: 6 SEP 2010

DOI: 10.1002/9781444328394.ch15

European Handbook of Neurological Management, Second Edition, Volume 1, Second Edition

European Handbook of Neurological Management, Second Edition, Volume 1, Second Edition

How to Cite

Gilhus, N. E., Barnes, M. P. and Brainin, M. (2010) Late (Complicated) Parkinson's Disease, in European Handbook of Neurological Management, Second Edition, Volume 1, Second Edition, Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781444328394.ch15

Author Information

  1. 22

    Department of Clinical Medicine, University of Bergen and Department of Neurology, Haukeland University Hospital, Bergen, Norway

  2. 23

    University of Newcastle, Hunters Moor Neurorehabilitation Ltd, Newcastle upon Tyne, UK

  3. 24

    Department of Clinical Medicine and Prevention, and Center for Clinical Neurosciences, Donau-Universität Krems, Department of Neurology, Landesklinikum Donauregion Tulln Tulln, Austria

Author Information

  1. 1

    Philipps-University of Marburg, Centre of Nervous Diseases, Germany

  2. 2

    Sapienza, Università di Roma, Italy

  3. 3

    Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Center, The Netherlands

  4. 4

    University of Pisa, Italy

  5. 5

    Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK

  6. 6

    Christian-Albrechts-University Kiel, Germany

  7. 7

    Oslo University Hospital and University of Oslo, Norway

  8. 8

    Institute of Molecular Medicine, Lisbon, Portugal

  9. 9

    Medical University of Warsaw, Poland

  10. 10

    Palacky University, Olomouc, Czech Republic

  11. 11

    Institute of Neurology CCS, School of Medicine, University of Belgrade, Serbia

  12. 12

    Katholieke Universiteit Leuven, Leuven, Belgium

  13. 13

    Central Hospital Bremerhaven, Germany, Sweden

  14. 14

    University Hospital, Lund, Sweden

  15. 15

    Innsbruck Medical University, Austria

  16. 16

    Laboratório de Farmacologia Clinica e Terapeutica e Instituto de Medicina Molecular, Faculdade de Medicina de Lisboa, Portugal

  17. 17

    INSERM CIC-9503, Hôpital Pitié-Salpétrière, Paris, France

  18. 18

    Bern University Hospital and University of Bern, Switzerland

  19. 19

    Universitat de Barcelona, Spain

  20. 20

    Paracelsus-Elena Hospital, Kassel, Germany

  21. 21

    University of Goettingen, Germany

Publication History

  1. Published Online: 6 SEP 2010
  2. Published Print: 15 OCT 2010

ISBN Information

Print ISBN: 9781405185332

Online ISBN: 9781444328394



  • late (complicated) Parkinson's disease;
  • motor complications, divided into motor fluctuations and dyskinesia;
  • patients with advanced Parkinson's disease (PD) - suffering from any combination of motor and non-motor problems;
  • European Agency for Evaluation of Medicinal Products (EMEA);
  • Levodopa-Immediate release (standard) - most important component of pharmacotherapy in advanced PD;
  • alternative levodopa formulations and delivery routes;
  • stimulation of posteroventral pallidum;
  • cued gait training in home - probably effective in reducing severity of freezing of gait;
  • biphasic dyskinesias, difficult to treat - have not been subject of specific and adequate Class I – III studies;
  • significant sleep disorders - being common in PD


This chapter contains sections titled:

  • Methods

  • Interventions for the symptomatic control of motor complications

  • Recommendations for the symptomatic control of motor complications

  • Interventions and recommendations for the symptomatic control of non-motor problems

  • References